4 Cornerstones Environmental Report

PICNET 2014

Linda Dempster Dr. Elizabeth Bryce

Sydney Scharf March 3, 2014

The 4 Cornerstones

• Prevents ARO spread • Prevents infection Hand Hygiene

• Prevents ARO spread • Provides clean equipment • Prevents infection

Environmental Program

• Improves quality • Reduces mistakes or omissions • Decreases adverse events • Alters microbial ecology

Antimicrobial Stewardship

• Improves quality • Reduces mistakes or omissions • Prevents infection • Improves patient perception/experience

Standard Protocols

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Key Elements of the 4 Cornerstones Program

• A VCH antimicrobial stewardship program to ensure appropriate, cost effective use of antibiotics on the clinical units within our hospitals

• An environmental management program to improve clinical equipment surface cleanliness as well as clinical equipment management on each clinical unit

• Implementation of a risk-managed approach to the isolation of VRE clients in an effort to support patient flow and reduce unit supply costs

• An equipment cleaning program

Partners • Aramark • Biomedical Engineering • BISS • CDI Working Group at VGH, Goldie Luong • Clinical Services • FMO • HSSBC • IMIS • Infection Control • Leslie Forrester & Epidemiology Team • Medical Microbiology • Pharmacy • Professional Practice • Simon Tse

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□ Wall mounted gloves

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Decluttering Before After

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Decluttering Cost Template Supplies

Quantity (per patient room)

Cost per unit Waste

22G x 1" Protectant IV 3060

$ 0.26 $ -

3M Brown Compressor Dressing - System 2

$ 5.02 $ -

3M Medipore Dressing Roll

$ 6.81 $ -

3M Tape

$ 0.62 $ -

3M Tegaderm Film 4" by 4 3/4" (1626W)

$ 0.89 $ -

3M Tegaderm Film 6cm by 7cm

$ 2.38 $ -

Suction Toothbrush

$ 2.56 $ -

Tegaderm Transparent Film Dressing with Border 3" x 4"

$ 1.77 $ -

Triumph Sterile Latex Gloves, Powder Free (6)

$ 0.70 $ -

Yankauer Suction Tube

$ 0.60 $ -

Time spent decluttering (in hours) People involved Number of patient rooms

Total 0 $ - Total per Unit

Milestones: Clean stretcher protocol

VGH June 27th

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RH • MECD- July 2nd

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RH • EQD opening - August

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LGH • MECD Program - July 9th • EQD opening - August 20th

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Wheelchair Amnesty LGH August 30 to September 20

• 15 returned

Green Means Clean VGH September

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Clean bed protocol VGH, LGH

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Equipment cleaning manual

• Inspired by VIHA

• Available online October 2013

• Shared with SPH and

Saskatchewan HA • Accreditation at RH

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Environmental Cleaning Outcomes

• De-cluttering • Introduction of PPE carts • Introduction of color coded microfiber cleaning

cloths and color coded buckets • Equipment management includes cleaning,

preventative maintenance, establishing par levels, and ensuring that the right piece of equipment is available and is clean at all times.

• Labeling/tagging

Color coded housekeeping cart

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• Regional inventory, 5 surplus beds and 2 walkers moved - transferred from UBC to VGH.

• Savings of approximately $ 5,200

• 8 commodes to LGH $8,000

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Equipment Management Benefits

Yellow Gowns BEFORE

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Yellow Gowns AFTER

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Personal size hygiene trial

2 units at VGH, ongoing. Now at 6 months.

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Benefits: 1. Decreased cross contamination 2. Less waste 3. Savings, neutral at 6 months 4. Patient satisfaction 5. Staff satisfaction 6. Non-quantifiable data but qualitatively

in favour of proceeding.

Decrease VRE patients isolated daily at VGH

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Before After

32 beds

7 beds

Savings:

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To Date Year Projected

Soap-Swap Out $46,435.04 $65,490.00

Lab Savings $64,830.00

Yellow Gowns $154,170.00

Decreased FTE Equipment Program $480,000.00

Decreased Stock Clerk $40,000.00

Linezolid Savings $202,237.00

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What is antimicrobial stewardship?

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ASPIRES Antimicrobial Stewardship Program –

Innovation, Research and Education for Safety

Clinical Care Education

Research Collaboration

Excellence

VGH Data

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Four Cornerstones VGH: Pre and Post Implementation

375

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50

100

150

200

250

300

350

400

Pre Post

Tota

l Num

ber

of C

ases

Total CDI Acquired at VGH (Pre & Post Implementation)

Sep 2012 - Dec 2013Jun 2011 - Aug 2012

↓ 30%

Next Steps

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• Sustain program • Patient rooms, begin cycle again • SOP – dock to dock regional inventory • Audits of MECD Program • Individual Hygiene Packs, regional • Safe/clean hospital – new way of doing

business • Green Means Clean • Focus, continued decrease of CDI

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Dollars saved Bed Days saved Patients protected from CDI

Target

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CDI

Questions

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